1474
drugs
either
Cat: Nitrates, beta blockers, calcium entry blockers & ACE inhibition
DECREASED INCIDENCE OF ATRIAL FIBRILLATION FOLLOWING OPEN
HEART SURGERY USING MODIFIED DEL NIDO CARDIOPLEGIA
D. Loberman1, R.C. Neely1, D. Fitsgerald1, S. McGurk1, T.K. Rajab1, I. Gosev1,
A. Grewal2, L.H. Cohn1, M. Leacche1, S.F. Aranki1
1. Brigham and Women's Hospital, Boston, MA, USA
2. Harvard Medical School, Boston, MA, USA
Background: Del Nido cardioplegia, a crystalloid based solution which includes
lidocaine and is given as a single dose, has been used in congenital cardiac surgery. We
retrospectively compared a modified del Nido solution—8 parts blood and 1 part
cardioplegia with lidocaine—with our conventional whole blood cardioplegia to
investigate the safety and efficacy in adult cardiac surgery.
Methods: From 6/1/13, we used a single dose of modified del Nido cardioplegia in 92
consecutive operations (Group I): 48 isolated Coronary Artery Bypass Graft (CABG), 31
isolated valve, 13 combined CABG and valve. We propensity matched 79 patients
operated on by the same surgeon (Group II) and 88 patients operated on by other
surgeons in the group (Group III) who received conventional whole blood cardioplegia.
Results: Group I was similar to Groups II and III in operative characteristics except
perfusion time of 82 minutes(range 64-127) in Group I vs. 108 minutes(84-139) in Group
III, p= 0.002, and cross-clamp time of 62 minutes(51–87) in Group I vs. 80 minutes(63–
102) in Group III, p = 0.011. Post-operative outcomes were similar including inotrope
requirements, ventilation time, length of stay (LOS, median 7 days, range 5-10) and
operative mortality (3.8%, 2.5%, 3.4% for Groups I, II, III, respectively). Atrial
fibrillation was significantly less frequent in Group I: 10% vs 25.3% (Group II, p =
0.021), vs 26.1% (Group III, p = 0.01). Median peak 24-hour CKMB levels were slightly
higher in Group I vs Group II (22.3 ng/ml, range 15.6 -40.3 vs. 18.4 ng/ml, range 13.9–
28.2, p = 0.04) and Group III(21.7 ng/ml, range 14.4-40.1 vs. 15.5 ng/ml, range 11.326.3, p = 0.003).
Conclusions: Modified del Nido cardioplegia is safe, effective, and associated with
decreased post-operative atrial fibrillation compared with conventional whole blood
cardioplegia. Higher CKMB levels did not translate into adverse clinical outcomes.